Mental health in the medical industry – time for action
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By Karen Stephens, MDA National
Doctors in distress
In August this year two recently graduated doctors committed suicide within a week of each other in New York. A fellow graduate doctor wrote in The New York Times:1
I imagine that they experienced fatigue, emotional exhaustion and crippling self-doubt at the beginning of those residencies – I know I did.
A beyondblue survey of Australian doctors and medical students in 2013 found that:
· doctors have a higher suicide rate compared with the general population, with female doctors more than twice as likely to suicide as females in the general population
· one in 10 doctors and one in five medical students had suicidal thoughts in the past year, compared with one in 45 people in the wider community
· 25% of doctors and more than 40% of medical students are highly likely to have a minor psychiatric disorder
· among doctors, 3.4% are experiencing very high psychological distress, much greater than the wider community. 2
Stressful work experiences
Stressors in a doctor’s workplace may include long hours, shift work, exposure to blood-borne diseases, being constantly judged on their performance, dealing with suffering and death, lack of resources in the health system, and the challenges of managing a business and employing staff.
Aggression from co-workers was found to be the cause of greatest harm to doctors’ health and happiness, according to new research published in the MJA.3
The stress of complaints or claims is also known to cause emotional and physical stress. An Australian study4 found that GPs with a current medico-legal matter had a higher prevalence of psychiatric morbidity, experiencing emotions such as distress, anger, fear, guilt, depressed mood, loss of confidence, feeling ashamed, insomnia and nightmares, loss of reputation and wanting to give up medicine.
Easing the distress
The graduate doctor writing in the New York Times opined:5
We need to be able to voice these doubts and fears. We need to be able to talk about the sadness of that first death certificate we signed, the mortification at the first incorrect prescription we ordered, the embarrassment of not knowing an answer on rounds that a medical student knew. A medical culture that encourages us to share these vulnerabilities could help us realize that we are not alone and find comfort and increased connection with our peers.
A recent American study found that only half of depressed interns obtained mental health services.6 Responses for avoiding help include lack of time, lack of confidentiality, a desire to manage their mental health independently, and professional stigma.
Nearly half of the interns in the study believed their colleagues would have less confidence in them as medical providers if they sought psychiatric treatment. Threat of judgment from other physicians serves as one of the largest barriers to seeking psychiatric care.
As a result of the beyondblue survey, a roundtable with key industry stakeholders from the medical profession was held in June 2014 and an action plan is being developed.
Developing a nationally consistent and comprehensive suite of services for doctors and medical students via doctors’ health advisory services was seen as one of the most practical strategies to improve access to resources. beyondblue plans to develop a national doctors’ mental health website.
The AMA recommends that doctors should:
· have their own GP
· make time for activities which nourish them as a person
· know about access to confidential services
· act if they are concerned about a colleague’s health.7
The RACGP’s Keeping The Doctor Alive covers coping strategies, lifestyle balance, boundary issues, management skills, personal support, medical support, and peer support. Download a copy at https://www.ranzcp.org/Files/Branches/Victoria/Keeping_the_Doctor_Alive-pdf.aspx
Keeping your grass greener by AMSA is a guide for medical students to maintain their health and wellbeing. Download a copy at http://www.amsa.org.au/projects/wellbeing/keeping-your-grass-greener/
Where to get confidential help
· Your MDO – MDA National has a Doctors for Doctors Program which provides support to our Members.
· Doctors’ Health Advisory Service/Peer Support Service – confidential support, information and advice. Help Lines in each state and territory are:
o ACT 0407 265 414
o NSW (02) 9437 6552
o NT (02) 9437 6552
o QLD (07) 3833 4352
o SA (08) 8366 0250
o TAS 1300 853 338
o VIC 1300 853 338
o WA (08) 9321 3098
· Bush Support Services – support for remote health workers. 24-hour Support Line:
1800 805 391
· Medical Benevolent Societies – support and advice for doctors, medical students and their families:
o ACT (02) 9987 0504
o NSW (02) 9987 0504
o SA (08) 8267 4355
· beyondblue 1300 22 4636
· Lifeline 13 11 14
 Sinha P. Why Do Doctors Commit Suicide? The New York Times September 4 2014.
2 National Mental Health Survey of Doctors and Medical Students www.beyondblue.org.au October 2013, available at http://www.beyondblue.org.au/about-us/programs/workplace-and-workforce-program/programs-resources-and-tools/doctors-mental-health-program.
3 Hills D & Joyce CM. Workplace Aggression in Clinical Medical Practice: Associations With Job Satisfaction, Life Satisfaction and Self-rated Health MJA 2014;201(9):535-540.
4 Nash L, Tennant C, Walton M. The Psychological Impact of Complaints and Negligence Suits on Doctors. Australasian Psychiatry 2004;Sep 12(3):278-81.
5 Sinha Op. cit.
6 McPartland AS. Suicide and the Young Physician The Atlantic Sep 16 2014.
7 AMA. Position statement: health and wellbeing of doctors and medical students 2011.